Chris first talked about different types of pain – acute and chronic; mechanical, thermal or chemical, and nociceptive or neuropathic pain.
The 3 main types of pathophysiology of chronic pain are:
1. Nociceptive – this is pain that results from tissue damage, such as seen with rheumatoid arthritis
2. Neuropathic – this results from pain that originates from the actual nerves
3. Hypersensitivity – results from over stimulation of nerves over a large area such as with fibromyalgia
Typical treatments of pain include:
- Analgesics – medications designed to relieve pain, such as opioids, aspirin, etc.
- Steroids – which decrease inflammation, but also have serious side effects
- NSAIDS – which also reduce inflammation
- Cold and heat therapy
- Physical therapy – helps to repair the damage
How NSAIDs work:
When there is an injury your body releases chemicals called prostaglandins. The chemicals are sent to site of injury and produce pain, fever, inflammation, support platelets to decrease bleeding, and help protect the lining of the stomach.
When you take an NSAID, it reduces the inflammation, pain and fever. However, they prevent platelets from clotting and can promote bleeding, and also prevent the protection of the stomach lining, so you are more prone to ulcers, which is why our patients cannot take them right before and after surgery.
Complementary and alternative therapies are frequently used by people to reduce pain, and while these exist outside normal health care practices, many have been found to help decrease pain.
The ones most highly rated are:
- Acupuncture – when used by an experienced practitioner, this can been a very effective way to manage pain
- Massage – is very effective for fibromyalgia and low back pain – works best for muscle related pain
- Tai Chi – the slow movements can be highly effective for osteoarthritis and degenerative joint disease
- Yoga – is very effective for low back pain, as it stretches out the nerves and can be modified as needed
- Chiropractics – depends on the practitioner, but can be helpful for musculoskeletal issues
- Relaxation – promising for fibromyalgia and low back pain (we have a relaxation CD that is available for those who want a way to do head to toe relaxation)
Therapies that have not been found to be as effective are aromatherapy, meditation, biofeedback, copper braclets and magnets, craniosacral therapy, hypnotherapy, imagery, Qigong, and reflexology. While many people practice these above and report relief, there is no science behind them It is recommended to try them a couple of times a week for a couple of months and if not relief, move on.
As far as supplements, the one used most extensively in Europe and is said to decrease or eliminate the used of NSAIDS after a few weeks is ASU – Avocado Soybean Unsoponifiables. Because Europeans use considerably less pain medication than in this county, they tend to use more natural sources. This is said to be as effective as NSAIDS when taken twice a day, although it takes a couple of weeks to get the best relief. It is available on Amazon.
Other frequently used supplements for joint pain are glucosamine and chondroitin. These supplements slow the progression of osteoarthritis and improve joint function. They are said to be as effective as Celebrex at doses of 800 – 1200 mg a day.
Fish oil supplements, which provide omega 3 fatty acids help to block inflammatory cytokines, or chemicals that are released with inflammation. Even rheumatologists have recommended OMAX 3, which is especially pure fish oil that decreases inflammation in rheumatoid arthritis. Flaxseed is high in linoleic acid, which is a type of Omega 3, but should be used with caution as it can act as a blood thinner.
The spice Ginger has an effect similar to a class of NSAIDS called Cox 2 inhibitors. It is taken in doses of 2 gm/day in food.
Indian Frankincense (300 – 400 mg a day_ slows cartilage damage and is a strong anti-inflammatory and analgesic.
Sam-e is a supplement that is used as a effective anti-inflammatory and analgesic that works well with B Vitamins. It has been studies and is said to work as well as Celebrex. It should be monitored by a PCP.
Any supplements should be cleared with a physician first to insure they do not counteract other prescription medication you are taking.
Another supplement that has gotten a great deal of press lately is CBD Oil – it is made from HEMP and is a major constituent of cannabis, or marijuana. However, CBD oil is supposed to have less than 0.3% THC, which is the substance that causes a “high” when ingesting or smoking marijuana. The only FDA approved form of CBD oil is Epidiolex, which is approved for use in seizure disorders in children. There have been many CBD oil shops pop up around the country, and it is important to know that 70% of the oil sold did not contain the amount stated on the label, and many had more THC than they are supposed to, which can lead to altered senses or depression.
As far as topicals, the best, which is by prescription only, is Voltaren gel. It does have to be used several times a day, and needs to be used regularly for best results. Capsaicin is made from the pepper family, and provides warmth to the affected area. Always wash hands after using. Aspercream, and Bengay are aspirin based creams and provide some relief, as do Lidoderm patches. There are helpful in the short term, but don’t work as well for chronic pain.
There are dietary modifications that can dramatically help prevent inflammation.
The main foods to avoid are:
- Saturated and trans fats
- Omega 6’s – corn oil, safflower, sunflower grapeseed, soy and peanut oil
- Refined carbohydrates like donuts, white breads, white rice and pasta
- Limit alcohol
- Nightshade vegetables (for some people) – tomatoes, peppers, eggplant, etc.
The best anti-inflammatory diet is to follow the Mediterranean diet, as most of the foods contain anti-inflammatories and antioxidants:
- Fish- especially cold water fatty fish – sardine, mackeral, salmon
- Veggies – broccoli, sweet potatoes, onion, kale and peas
- Olive oil and safflower oil
- Nuts – walnuts are the best
- Green tea